Difference between revisions of "Intertrochanteric femur fracture"
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{{Femur fracture types}} | {{Femur fracture types}} | ||
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==Management== | ==Management== | ||
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| + | ===Specific Management=== | ||
| + | *Ortho consult | ||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
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| + | ===Specialty Care=== | ||
| + | *Typically requires ORIF | ||
==See Also== | ==See Also== | ||
Revision as of 05:43, 18 September 2019
Contents
Background
- Occur via fall in elderly or osteoporotic
Clinical Features
- Typically pain, swelling, ecchymosis
- May lose 1-2L of blood
- Unable to bear weight
- Shortening and external rotation if fracture is significantly displaced
Differential Diagnosis
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
Evaluation
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
Evaluation
- Stable (Garden's type I and II)
- Lesser trochanter non-displaced, no comminution, medial cortices of prox/distal fragments aligned
- Unstable (Garden's type III and IV)
- Displacement occurs, comminution is present, or multiple fracture lines exist
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Ortho consult
Disposition
- Admit
Specialty Care
- Typically requires ORIF